How Value-based Solutions Can Improve Costs and Health Outcomes for Chronic Conditions

More than 125 million Americans suffer from chronic conditions. Poor management of these conditions can lead to dire consequences, like hospitalizations, acute health events, and death. These challenges are not new, but they’ve been exacerbated by the COVID-19 pandemic.

Since 2020, we’ve seen a concerning shift in accessing and managing care: more individuals are not adherent to their therapy or are canceling regular visits with their providers, which accelerates disease progression and increases costs. With the U.S. spending approximately $3.4 trillion dollars on chronic conditions each year, the costs of inadequate condition management is something plan sponsors cannot afford to ignore.

Value-based solutions can help.

These solutions combine cost-containment strategies, like utilization management, discontinuation credits and direct payments to plans, and patient engagement tools to not only lower the costs of specialty and traditional drugs, but also to promote better chronic condition management and drive down total medical costs.

Specialized support and adherence tools linked to lower downstream medical spend

Offering targeted condition management tools that are connected, compatible and convenient with members’ lives ensures they keep their health on track and costs in check. Personalized coaching, medication adherence monitoring and condition-specific digital tools are just a few resources that value-based solutions offer to keep members engaged, adherent and healthy. Reducing the risk of acute health events helps avoid ER visits, hospitalizations, and ultimately, higher costs to members and their plan sponsors.

This is no longer a theory. In fact, here are a few examples of how Evernorth’s platform of condition-specific value-based solutions, SafeGuardRx^®, improved health outcomes for members and, in turn, improved medical spend:

• Members lost over 480,000 pounds¹ with the aid of a digital engagement tool. By promoting healthy weight loss and preventing the onset of type 2 diabetes, this solution helped plans save an average of $70 per participant per month in health care costs.  
• Members in value-based programs are more adherent. As a platform, adherence for SafeGuardRx is 14.5% higher than industry averages for adherence among members with chronic illnesses.
• 17.2% of members enrolled in the diabetes value-based program added a statin to their therapy regimen in 2021. If all plan sponsors similarly increased statin use among diabetes patients, more than 20,000 heart attacks could be avoided over the next 10 years, saving $21,500 in medical spend per patient.

Long-term impacts to plans and to members

Value-based solutions provide affordable access to medications along with targeted tools and support to ensure the best possible health outcomes. With a growing population of Americans being diagnosed with one or more chronic conditions, these tools and resources will only become more valuable as medications continue to get more expensive and chronic conditions become more difficult to manage.